Abstract No. 194: Local regional intervention in hepatocellular carcinoma (HCC): pathological complete response (pCR) to pre-transplant treatment correlates with improved survival

Evaluate whether response to local therapy for HCC pre transplant predicts tumor free survival after Orthoptic liver transplant (OLT). We retrospectively reviewed our data base to select consercutive patients with HCC who underwent OLT between 2004-2008. Some patients received tumor treatments to control tumor size prior to transplant. Treatment options were chemo-embolization, RFA, Yttrium 90 (Yt90) ETOH, tumor resection or a combination. Final tumor stage was made at removed liver. Patients were followed clinically, by lab values and by imaging. There were 57 patients with HCC who underwent OLT between 2004-2008. 39 were locally treated and 18 were not prior to transplant. The tumor stage in 18 of 57 (32%) patients was initially outside of the Milan criteria. 6 of 57 had pCR, 2 outside Milan criteria. The median age at presentation was 57±7 years, and the median AFP at OLT was 8.4ng/ml. Thirty-nine (68%) patients received 1 to 3 pre-transplant treatment modalities. Chemo-embolization was performed in 26 patients; RFA in 20, Yt90 in 5, alcohol in 2, and tumor resection 3. The median overall survival was 19 months. The tumor recurred in 10 (17.5%) patients, and all recurrences were distant metastases. Multivariate logistic regression analysis shows correlation predicting improved survival after OLT to: pCR in pre-transplant therapy, well-differentiated tumor histology, and younger age. All 6 patients with pCR are alive without evidence of tumor recurrence. Survival after OLT in patients with tumors slightly outside Milan criteria is comparable to survival of patients with tumors within the Milan criteria (25 months vs. 29 months, p=0.69); however tumor recurrence rate was higher (27% vs 13%). In patients undergoing OLT for HCC, pCR to Pre-Transplant Local regional intervention, well differentiated tumor histology, and younger age correlate with longer survival following OLT in patients with tumors. Having modestly expanded Milan criteria does not result in inferior survival.